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Physician describes switch of patients from oral systemics to biologic therapy
New York - With the availability of biologic medications for psoriasis, dermatologists need not take a back seat to other medical subspecialties whose physicians have been using biologics for years, according to Alan Menter, M.D.
Dr. Menter and his colleagues William Abramovits, M.D., Carole Aponte, M.D., and Jennifer Cather, M.D., who have treated hundreds of patients with moderate to severe psoriasis, have switched one-third of their more than 700 patients on oral systemic therapy to biologic therapy. Dr. Menter described what he has learned during a year and a half of giving biologics to patients with moderate to severe psoriasis at the American Academy of Dermatology Academy '04.
"Most of these patients have had too much methotrexate or cyclosporine, were females of child-bearing potential, have had hepatitis C, have had hypertension or were not otherwise candidates for standard therapy," he says. "Some patients want to drink alcohol socially, which is precluded with methotrexate." Prebiologic medications (mainly methotrexate and cyclosporine), though therapeutically effective, cannot be used for long-term maintenance due to their side effects, he adds.
Psoriatic arthritis more prevalent "We previously thought patients with psoriatic arthritis were 10 percent of the psoriatic population," Dr. Menter says. "After working with the rheumatologists, we now think it's more than 30 percent. Since these patients present to us with their skin disease five to 10 years before their joint disease, we should be looking out for joint disease."
Dr. Menter and his colleagues have joined the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), an international organization of dermatologists and rheumatologists.
"As the rheumatologists learn more about psoriasis, we as dermatologists learn more about psoriatic arthritis," he says. "It has been a very beneficial mutual relationship."
With Enbrel having U.S. Food and Drug Administration (FDA) clearance for both psoriasis and psoriatic arthritis, Dr. Menter has transitioned many patients previously taking just methotrexate or nonsteroidal anti-inflammatory drugs for their arthritis to Enbrel.
"Patients with psoriatic arthritis feel better within a week or two (when given Enbrel)," he says. "They get up and exercise and don't have early morning stiffness. But for the skin disease, in the standard dose approved for rheumatoid arthritis, Enbrel does not work as quickly, and thus we've had to double the initial dose of Enbrel for psoriasis."